The cost accounting of shelter killing in Texas

A recent opinion by the Texas Board of Veterinary Medical Examiners (TBVME) threatens to derail the no-kill achievements of Austin and the rapid progress toward no-kill being made in San Antonio and other Texas cities. The TBVME ruling is the subject of a lawsuit brought by no-kill leader Ellen Jefferson, DVM of Austin and executive director of Austin Pets Alive.

At issue is the matter of shelter veterinary medicine vs. private practice veterinary medicine and the low cost of shelter killing in Texas.

All pet owners are familiar with private veterinary practice. You make an appointment for either a routine check-up or for a specific health concern you may have about your animal friend. The veterinary office looks increasingly like that of your own primary care physician – clean, well-lit and reassuringly disinfected. You meet the vet privately, discuss your pet’s health and come to some agreement about the recommended vaccines, treatments or advanced diagnostics, etc., and the cost of services to be rendered. The veterinary office keeps a detailed record of your pet’s health and over time will develop a healthcare profile for the animal. Such care is increasingly specialized, high-tech, time-consuming and expensive. It is estimated that pet owners will spend $15 billion on veterinary care in 2014.

By contrast, shelter veterinary medicine is an entirely different animal and can be characterized in layman’s terms as follows:

• First of all, rather than operating in a for-profit environment, shelter vets operate under the nonprofit umbrella of the sheltering agency, be that a municipal shelter or a local humane society or society for the prevention of cruelty to animals that manages an animal control contract. For the purposes of veterinary care, shelter animals are not owned by private individuals but are the property of the shelter. When a shelter vet is presented with a dog or cat with no owner ID, they have no idea of the pet’s medical records or prevailing health issues, including vaccination history, any medication that the animal might be on, including pain meds, or any other ongoing treatment for an existing condition, such as diabetes or thyroid problems.

• Cost of care is also an issue, if not the issue, in delivering individualized care to shelter animals. Rather than a caring and informed pet owner covering the cost of care, shelter vets operate under an imposed budget intended to cover the cost of care of every animal entering the shelter system for the budgetary year. A shelter vet can’t just order up a blood panel, ultrasound or an MRI for any animal whose condition they believe might warrant a deeper dive. The only animals that most shelters can afford to provide specialized care for are those who arrive at the shelter with an obvious injury or treatable medical condition, and sadly, in many shelters, even those animals arriving with injuries, such as broken bones, are often given little if any care.

• Most rural and small town shelters do not have funding to hire a veterinarian to be on duty seven days per week. Rather, they employ a part-time veterinarian who establishes basic medical protocols for shelter staff to implement, elevating only the most critical and dangerous medical issues to the attention and limited availability of the shelter vet. This allows the shelter staff to address everyday medical issues to prevent contagion and save lives between veterinary visits.

• Animals in a shelter setting are not seen by appointments that conform to a vet’s preferred allotment of time for care and attention to individual animals, but rather they arrive at the shelter in an uncontrolled stream determined by the number of field calls, owner surrenders and stray turn-ins on any given day, further mitigating against protocols that favor individualized care.

• Finally, animals in the care of private practitioners live in private homes and are not subject to the stress of a shelter or exposure to random infectious diseases that float around an animal control facility.

As a result of the glaring differences between private and shelter veterinary medicine, shelter vets are obliged to focus on disease prevention and the collective health of all animals in the shelter, along with only the most immediate and glaring needs of any one individual. Consequently, shelter medicine is often likened to “herd health management” as practiced by farm vets who must be concerned about large numbers of animals that share pasturage, water, food troughs and bedding. The term of art for this approach to shelter medicine is “population level” medicine to distinguish dogs and cats from herd animals.

So, getting back to the trouble in Texas, the TVBME recently ruled that the same standards of care apply to shelter vets as those applied to private practice, pay-for-services vets despite the world of difference between the two environments and discrepancy of available resources. If upheld in court, this ruling would drive up the cost of shelter medicine and potentially force cash-strapped shelters to cap that type of mandated expense.

The most likely cost-cutting measure that shelters will default to is killing more shelter pets because lurking in the background is a decades-old Texas law that allows shelter staff (with only 12 hours of education) to legally purchase and administer the barbiturate used to euthanize animals. Further, it is not necessary for a veterinarian to be present to oversee the process, making the killing of animals in Texas shelters cheap and easy. If Texas pulls the plug on low-cost shelter medicine protocols and imposes the standards of care applied to private practice, the cost accounting of killing shelter pets versus implementing lifesaving programs will be a calculation that many Texas shelters will be forced to make.

Since the consequence of the TVBME ruling will be an increase in shelter deaths, their motivation is clearly not in the interest of animal health and welfare or consumer protection because the consumer in this instance is the shelter. Their actual motivation is unclear, but I suspect that it has more to do with veterinary income than it does with veterinary ethics.

Dr. Jefferson is a champion of low-cost and effective shelter medicine, which she candidly describes as occasionally resembling working in a war zone MASH unit, and is suing the TVBME to reverse this dangerous finding and to formally define the long-standing protection that has enabled shelter veterinary medicine to save lives.